The Evolution Of Adult Care Homes
As the concept of how a family functions in the US began to change in the late 1970’s and more and more women began joining the workforce, the ability to care for our aging parents also began to change. In the early 1980’s, a new industry evolved to fill the niche – care provided by paid caregivers.
Prior to the creation of adult care homes, seniors needing care had only two options. If they didn’t require too much care, they moved into the home of one of their adult children. If they were confused, or if they had difficulties with mobility, or if they needed personal care that their adult children weren’t comfortable extending, then the only alternative was a nursing home. It was not uncommon for people in the 1980’s to live for five to twenty years in a nursing home.
As healthcare began to evolve, so did our expectations of what type of living environments we found acceptable for our aging parents. Treatments, cures, medications and medical advancements meant a higher percentage of people were able to live into their 80’s, 90’s and even 100’s.
The healthcare industry changed its view on how long people should remain in the hospital. No longer was it customary to stay in the hospital until full recuperation was reached. Instead, hospitals only kept people until they became medically stable and then people were moved to a nursing home, or they were sent home with in-home care for a short time. This change had a dramatic effect on nursing homes. Instead of having rooms with four long-term residents living in a room, nursing homes became rehabilitation centers where semi-private or private rooms were offered for short-term recuperative stays. Nursing homes went from being places where people lived long-term to being places where people spent two to six weeks to get physical therapy and to be monitored by staff 24 hours a day. There is a continued trend within nursing homes to move away from providing long-term care, and instead, focus is placed on short-term rehabilitative stays.
To meet the long-term needs of elderly, three new industries co-evolved in the 1980’s. Adult care homes, assisted living communities and in-home care agencies. Adult care homes go by different names in various states. Homes providing senior care in Washington state were called adult family homes, in Oregon they were called adult foster care, and in California they were called residential care homes.
Each state defines the parameters of the number of residents that may live in an adult care home. Washington allows six residents in a home, whereas Oregon allows only five. The number of residents allowed in a home is also contingent upon other factors, so some homes may care for only two to four residents. Some homes may qualify to care for more residents, but choose to care for a smaller number of residents.
In the late 1980’s the number of adult family homes in Washington & Oregon surged. This is because the regulations to open and operate a home were limited. People who were paying privately for care in a nursing home were motivated to choose an adult care home because the pricing was substantially less; an adult care home was about 40% of the cost of a nursing home. And, because people were living longer, more and more elderly people were outliving their savings. The states of Washington and Oregon found it much less expensive to arrange for care in an adult care home than in a nursing home.
There were about the same number of homes in the early 1990’s as there are today. Increasing regulations turned what used to be a cottage industry into complex businesses that operate much like nursing homes did in past decades.
Today there are three distinct types of adult care homes.
- Approximately 30% of the homes provide care to people who are able to pay privately for the services they require; these homes tend to be staffed with more caregivers, and may offer 24-hour awake staff or assistance with all levels of care needs.
- Nearly half the homes now focus on caring for people who are in the process of spending down their assets or who already ready state assistance to pay for their care.
- Another type of adult care home provides services to the developmentally disabled.
For individuals paying privately for care or those who own long-term care insurance policies, the options are abundant.
Over the past ten years, there has been a significant decrease in the Medicaid reimbursement rate by the states of Washington and Oregon to compensate homes for residents who are unable to pay for their own care. As a result, there has become a large divide in the quality of homes which care for people with assets versus those who rely upon Medicaid.
With the amount of skill it takes to operate a home, and the amount of regulations that exists, very few new adult care homes are opening; and many of the homes that previously only accepted Medicaid clients are having to close their doors because they cannot afford to operate.
Adult family homes in Washington and adult foster homes in Oregon are a critical part of the continuum of care for older adults. As a society, we need to work on how to dial back the expectations of state governments to place layer upon layer of restrictions on homes. Also as a society, we need to give focus on how funding can be increased for this important segment of care.